高血压引发舒张性心衰的原因和治疗建议

本文探讨了高血压和舒张性心力衰竭的关系,从临床病例和发病机理等方面阐述高血压引发舒张性心力衰竭的原因。最后,根据目前的研究现状,针对舒张性心力衰竭的治疗提出了建议。     

复方卡托普利治疗舒张性心力衰竭87例

目的：探讨复方卡托普利治疗舒张性心力衰竭（DHF）的临床效果;方法：选取我院87例舒张性心力衰竭患者,随机分为治疗组43例和对照组44例,治疗组加用复方卡托普利,对比两组治疗前后临床症状及左心室超声舒张功能指标改善情况;结果：治疗组较对照组治疗后临床症状改善有明显差异,而对照组治疗前后无明显差异;结论：通过对87例舒张性心力衰竭患者的治疗,认为复方卡托普利是较为理想的治疗舒张性心力衰竭的药物,尤其对高血压性心脏病引起的左室舒张功能衰竭的患者疗效更佳。     

舒张性心力衰竭临床特征分析

目的分析舒张性心力衰竭临床特征。方法随机抽取近几年来在我院就诊的舒张性心力衰竭患者43例作为观察组,并抽取同期到我院就诊的收缩性心力衰竭患者43例作为对照组,以此分析患者临床特征。结果观察组年龄较对照组高,女性多于对照组,高血压、心房颤动发生率高于对照组,NYHAⅢ级高于对照组,NYHAⅣ级低于对照组,心电图QRS时间短于对照组,LVESD、LVEDD低于对照组,LVEF、室间隔厚度高于对照组,差异有统计学意义(P0.05)。结论舒张性心力衰竭多见于女性,病情程度较收缩性心力衰竭低,左房扩大,舒张功能异常。     

美托洛尔缓释片治疗高血压并舒张性心力衰竭疗效体会

目的:研究美托洛尔缓释片治疗高血压并舒张性心力衰竭的疗效。方法:将我院收治的52例高血压并舒张性心力衰竭患者作为研究对象,按照床位号将其平均分成两组,各26例。对照组使用左旋氨氯地平治疗,观察组在对照组基础上使用美托洛尔缓释片治疗,比较两组的治疗效果。结果:观察者治疗后的心率、舒张压、收缩压、LVEF水平均比对照组好;观察组的治疗总有效率比对照组高,两组间有较大的差距,P0.05,有统计学意义。结论:使用美托洛尔缓释片治疗高血压并舒张性心力衰竭的疗效确切,值得在临床中推广应用。     

舒张性心力衰竭的研究现状

舒张性心力衰竭(DHF)是指一组具有心力衰竭症状和体征、左心室射血分数(LVEF)正常而以心室肌舒张功能障碍、顺应性减退、僵硬度增高为特点的临床综合征[1]。随着人口老龄化,DHF的发病率有逐年增加的趋势。研究资料显示,DHF多见于高血压性心脏病,其次为冠心病、肥厚型心肌病     

螺内酯治疗老年高血压并发舒张性心力衰竭的疗效分析

目的：分析螺内酯治疗老年高血压并发舒张性心力衰竭的疗效。方法：选取我院2011年4月至2014年4月收治的62例高血压并发舒张性心力衰竭老年患者为研究对象,抽签将其分为两组,各31例,对照组患者采取钙拮抗剂、β-受体阻滞剂等常规治疗,实验组患者则在对照组基础上给予螺内酯治疗,对两组患者治疗前后左室舒张功能、生化指标及6分钟步行试验结果等进行对比分析。结果：实验组患者治疗后6分钟步行距离（542.82±55.55）m,对照组治疗后步行距离（434.34±46.02）m,两组比较差异有统计学意义,P〈0.05。另外实验组患者治疗后左室舒张功能（E值、A值、E/A值）、主要生化指标明显优于对照组,差异有统计学意义,P〈0.05。结论：螺内酯治疗老年高血压并发舒张性心力衰竭效果明显,能提高患者运动耐受能力及心脏功能,值得临床进一步应用。     

洛汀新治疗高血压并舒张性心力衰竭的疗效

目的评价洛汀新治疗高血压合并舒张性心力衰竭的疗效。方法入选72例高血压患者,经心脏彩色超声心动图证实为左室舒张功能不全,收缩功能正常,采用随机对照的方法,将72例患者随机分为对照组（36例）和治疗组（36例）,对照组予以硝苯地平缓释片、改变生活方式等治疗,治疗组在对照组治疗方案的基础上加用洛汀新治疗。测定治疗前后心功能、血压、心率、左室舒张末期内径（LVDd）、血糖、血脂、心电图等指标。结果治疗2～3周后,治疗组血压、心率、LVDd降低,左室舒张功能明显改善,与对照组比较有显著性差异（P〈0．05）。结论洛汀新是治疗高血压并舒张性心衰较为理想的药物。     

射血分数保留性心力衰竭相关生物标志物概述

既往对心力衰竭的研究将左心室射血分数(left ventricular ejection fraction,LVEF)在45%~50%之间的心力衰竭描述为舒张性心力衰竭。随着研究的深入发现,不仅有些心力衰竭患者没有LVEF明显下降的表现,而且在一些LVEF <35%的收缩性心力衰竭患者中也同样存在心脏舒张功能的损伤。"舒张性"一词已然不适用于描述心力衰竭的分类。     

舒张性心力衰竭和收缩性心力衰竭的临床比较分析

目的对比舒张性心力衰竭和收缩性心力衰竭的临床指标。方法选取2016年4月至2019年4月我院收治的60例舒张性心力衰竭患者(舒张性组)和60例收缩性心力衰竭患者(收缩性组),对比两组患者的左心形态学指标、心功能指标,记录同心功能分级患者的血清NT-proBNP水平。结果两组的左室舒张末期内径、 LVEF、左心房内径、左心室后壁厚度、心室间隔厚度比较,差异有统计学意义(P <0.05)。两组的心脏指数、 IRT、 E/A、 EDC比较,差异有统计学意义(P <0.05)。收缩性组的血清NT-proBNP水平明显高于舒张性组(P <0.05)。结论与收缩性心力衰竭相比,舒张性心力衰竭的病情更严重,应加强早期诊治,并结合血清NT-proBNP判断心力衰竭类型,指导治疗,改善预后。     

心力衰竭的诊断与治疗进展

心力衰竭 (CHF)是一种复杂的临床症状群 ,是高血压、冠状动脉硬化性心脏病、瓣膜性心脏病、心肌病和糖尿病等常见病引起的临床综合征 ,是各种病因心脏病的严重阶段。文献报道 ,成年人群中心力衰竭发生率 1 5 % ,心力衰竭诊断后 4年病死率达 4 0 % ,6年病死率男、女分别为 80 %和 6 5 %。心力衰竭患者住院率只占同期心血管病的 2 0 % ,死亡率却达 4 0 %。1　诊　断心力衰竭按病程发展的速度可分为急性和慢性心力衰竭 ,按部位分为左心、右心和全心衰竭 ,按心脏缩舒功能变化又分为收缩性和舒张性心力衰竭。1 1　急性心力衰竭　急性心力衰竭是…     

Diastolic heart failure

Diastolic heart failure is predominantly a disease of the elderly: at the age of 70 years, almost half of all patients with heart failure have diastolic heart failure. Hypertension and obesity are common underlying disorders in patients with diastolic heart failure. Patients with diastolic heart failure have an equal, or only slightly better, prognosis in terms of mortality compared to patients with systolic heart failure. Echocardiography can distinguish diastolic heart failure from systolic heart failure. Patients with heart failure and a normal ejection fraction almost certainly have a diastolic dysfunction. There is a lack of reliable data about the optimal medicinal treatment strategy for patients with diastolic heart failure. Angiotensin-converting enzyme (ACE) inhibitors, beta-blockers, and (non-dihydropyridine) calcium antagonists have therapeutic potential. Digoxin may be contraindicated.     

血浆N末端B型脑钠肽前体联合6分钟步行试验法对慢性心力衰竭的诊断价值观察

目的 探讨血浆N末端B型脑钠肽前体(NT-proBNP)与6 min步行试验法(6MWT)联合评估对慢性心力衰竭(CHF)的诊断价值。方法 选取2017年1月—2019年1月于本院就诊的CHF患者80例,设为观察组,并选取同期健康体检者50人,设为对照组,并将观察组根据NYHA分级分为Ⅱ、Ⅲ、Ⅳ级,且根据左室舒缩功能分为舒张性心衰、收缩性心衰及混合型心衰。比较观察组与对照组血浆NT-proBNP水平、6MWT距离及心功能指标;并比较舒张、收缩及混合型心衰间NT-proBNP水平、6MWT距离。结果 对照组6MWT距离、LVEF、E/A>心功能Ⅱ级患者>心功能Ⅲ级患者>心功能Ⅳ级患者,对照组NT-proBNP水平<心功能Ⅱ级患者<心功能Ⅲ级患者<心功能Ⅳ级患者,差异有统计学意义(P<0.05);舒张性心衰6MWT距离(273.58±53.24)m>收缩性心衰的(235.14±48.33)m>混合型心衰的(219.48±51.62)m,舒张性心衰NT-proBNP水平(1 654.15±547.24)pg/mL<收缩性心衰的(3 728.42±719.38)pg/mL<混合型心衰的(4 071.41±849.59)pg/mL,差异有统计学意义(P<0.05)。结论 血浆NT-proBNP与6 min步行试验法联合对慢性心力衰竭患者诊断具有重要价值,可有效提高心功能分级准确度,并为临床治疗提供更为优质的指导。     

N末端B型利钠肽在高血压病合并冠心病心力衰竭中的意义

目的：探讨高血压病对冠状动脉粥样硬化性心脏病舒张性心力衰竭病人血N末端B型利钠肽水平的影响。方法：住院诊断的高血压病合并冠状动脉粥样硬化性心脏病舒张性心力衰竭病例65例和同期不伴有高血压病的冠状动脉粥样硬化性心脏病舒张性心力衰竭病例55例,检测血N末端B型利钠肽,所有病例均做超声心动图检查。结果：两组病例血N末端B型利钠肽分别为4815.66±2762.53pg.L-1和3214.87±1985.81pg.L-1,两组有显著性差异;两组高于心力衰竭截点水平的例数为60/65例（92.31%）和46/55（83.64%）,两组有显著性差异。结论：合并有高血压病的冠状动脉粥样硬化性心脏病舒张性心力衰竭病人血N末端B型利钠肽较没有高血压病的冠状动脉粥样硬化性心脏病舒张性心力衰竭病人血N末端B型利钠肽更容易增高,而且增高幅度更大。     

Congestive heart failure due to diastolic or systolic dysfunction. Frequency and patient characteristics in an ambulatory setting.

OBJECTIVE: To determine the age- and sex-specific frequencies and characteristics of patients with diastolic and systolic dysfunction heart failure. DESIGN: Retrospective medical record survey encompassing 1 year. SETTING: Community-based family practice office. PATIENTS: One hundred thirty-six patients who met the modified Framingham criteria for the diagnosis of congestive heart failure (CHF) and had a known left ventricular ejection fraction. Diastolic dysfunction was defined as an ejection fraction of 45% or greater and systolic dysfunction heart failure as an ejection fraction of less than 45%. MAIN OUTCOME MEASURES: Age- and sex-specific frequency; patient comorbid conditions; medications taken; and number of emergency department visits, hospitalizations, and deaths. RESULTS: The frequency of CHF increased with age for men and women (1.3% for patients 45-54 years old to 8.8% for patients > 75 years old). The distribution according to left ventricular ejection fraction and age varied according to sex. Women had later onset of CHF that was predominantly diastolic dysfunction heart failure. Men had proportionately more systolic dysfunction heart failure at all ages. Forty percent of all patients with CHF had diastolic heart failure, and these patients had fewer functional limitations (76% with New York Heart Association classes I and II), fewer hospitalizations for CHF, and a trend toward fewer deaths during the study year compared with patients with systolic dysfunction. CONCLUSIONS: Congestive heart failure is a heterogeneous condition in this family practice setting, and diastolic dysfunction heart failure occurs frequently. Further study of the natural history and treatment of diastolic dysfunction heart failure should be performed in the primary care setting.     

Experiences with serum BNP (B type natriuretic peptide) in patients with systolic and diastolic heart failure

Current study confirms and extends recent observations concerning the diagnostic usefulness of B type natriuretic peptide. It discriminates well between dyspnea of cardiac and non-cardiac origin in the unselected population. Echocardiography represents useful diagnostic tool for assessment of systolic and diastolic ventricular function. In diastolic heart failure the elasticity of left chamber decreases due to the increase of the filling pressure. B type natriuretic peptide predominantly derived from the atrial tissue in patients with chronic heart failure. In the literature contradictory data has been found about serum B type natriuretic peptide level and diastolic dysfunction in cases with good left ventricular function. Authors reviewed 35-34 unselected patients with chronic systolic and isolated diastolic dysfunction. The serum B type natriuretic peptide level increased significantly in all the systolic heart failure patients, while, in patients with isolated diastolic heart failure the values were increased only cases with increased atrial value (calculated to the body surface).     

Treatment of diastolic dysfunction in hypertension

Diastolic dysfunction is present in half of patients with hypertension and has been shown to be associated with increased cardiovascular morbidity and mortality, as well as the development of heart failure. With the high prevalence of hypertension and its associated complications, treatment of diastolic dysfunction in hypertension is an important and desirable goal. Angiotensin converting enzyme inhibitors and angiotensin receptor blockers have been shown to be effective in improvement of measures of diastolic function and are recommended as first-line agents in the control of hypertension in patients with diastolic heart failure. Beta-blockers, calcium channel blockers, and diuretics have also shown some efficacy in improved indices of diastolic filling. However, the independent impact of these pharmacologic interventions on prognosis and outcome in diastolic dysfunction has yet to be clarified. The Irbesartan in Heart Failure with Preserved Ejection Fraction (I-PRESERVE) study, Candesartan in Heart Failure: Assessment in Reduction of Mortality and Morbidity (CHARM-Preserved) trial and the Losartan Intervention For End-point Reduction in Hypertension (LIFE) Study all failed to show improved morbidity and mortality with these drugs although, the LIFE study showed reduced heart failure hospitalization in hypertensive patients with normal in-treatment diastolic function. The Trial Of Preserved Cardiac function heart failure with an Aldosterone anTagonist (TOPCAT) is an on-going large, international study evaluating the effect of spironolactone on cardiovascular mortality, aborted cardiac arrest, or hospitalization for diastolic heart failure. This and other studies will provide further insight into the pathophysiology and management of patients with diastolic dysfunction.     

Diastolic heart failure

The rhythmic contraction and relaxation of the heart supply the body with the appropriate amount of blood. If the pump function deteriorates, heart failure occurs. After a symptom-free period of varying length, the clinical case of decompensatio cardiaca develops. The pathophysiological basis of the disease is abnormal systolic and/or diastolic function. The pathophysiology and therapy of systolic heart failure is well-known, however, the consequence of impaired diastolic function has not been fully revealed. Both cardiogenic shock and pulmonary edema can be caused by acute left heart failure. The main difference between the two disorders is that while cardiogenic shock is caused by systolic dysfunction, pulmonary edema is the consequence of impaired diastolic function. The importance of diastolic dysfunction is highlighted by the fact that the disorder can be caused by the most frequent diseases (hypertension, diabetes mellitus, coronary heart disease, myocardiac infarction). Consequently, in case of risk factors, it is very important to consider the possibility of diastolic dysfunction and be aware of the diagnostic and therapeutic options.     

Diastolic heart failure: a review and primary care perspective

Previously the subject of much debate, there is now consensus that diastolic heart failure (DHF) represents a distinct form of heart failure. Epidemiologic data indicate that DHF is common. Indeed, there is evidence that, among elderly persons, DHF is more common than systolic heart failure (SHF). Like SHF, DHF is associated with significant morbidity, mortality, and cost; however, few clinical trials focusing on isolated DHF have been completed. Much of the treatment of DHF is based on current concepts of the pathophysiology of DHF, small clinical studies, and experience gained from treating patients with SHF. The diagnosis of DHF is clinical; data supporting the establishment of a diagnosis of DHF are limited. Differences exist in prognosis and treatment between diastolic and systolic heart failure. This article reviews diastolic heart failure with emphasis on evidence-based management, aimed at primary care physicians who routinely provide care to patients with DHF.